Letteratura scientifica selezionata sul tema "New York (State). Psychiatric Institute of the State Hospitals"

IntroductionEffective, brief, low-cost interventions for suicide attempt survivors are essential to saving lives and achieving the goals of the National Strategy for Suicide Prevention and Zero Suicide. This study aims to examine the effectiveness of the Attempted Suicide Short Intervention Program (ASSIP) in averting suicide reattempts in the United States healthcare system, its psychological mechanisms as predicted by the Interpersonal Theory of Suicide, and the potential implementation costs, barriers and facilitators for delivering it.Methods and analysisThis study is a hybrid type 1 effectiveness–implementation randomised controlled trial (RCT). ASSIP is delivered at three outpatient mental healthcare clinics in New York State. Participant referral sites include three local hospitals with inpatient and comprehensive psychiatric emergency services, and outpatient mental health clinics. Participants include 400 adults who have had a recent suicide attempt. All are randomised to ‘Zero Suicide-Usual Care plus ASSIP’ or ‘Zero Suicide-Usual Care’. Randomisation is stratified by sex and whether the index attempt is a first suicide attempt or not. Participants complete assessments at baseline, 6 weeks, and 3, 6, 12 and, 18 months. The primary outcome is the time from randomisation to the first suicide reattempt. Prior to the RCT, a 23-person open trial took place, in which 13 participants received ‘Zero Suicide-Usual Care plus ASSIP’ and 14 completed the first follow-up time point.Ethics and disseminationThis study is overseen by the University of Rochester, with single Institutional Review Board (#3353) reliance agreements from Nathan Kline Institute (#1561697) and SUNY Upstate Medical University (#1647538). It has an established Data and Safety Monitoring Board. Results will be published in peer-reviewed academic journals, presented at scientific conferences, and communicated to referral organisations. Clinics considering ASSIP may use a stakeholder report generated by this study, including incremental cost-effectiveness data from the provider point of view.Trial registration numberNCT03894462.

Harvey S. Levin obtained his Bachelor’s degree from City College of New York, in New York city, Ph.D. in Clinical Psychology from the University of Iowa, in Iowa City, completed his internships in Clinical Neuropsychology and Pediatric Psychology at the University of Iowa Hospitals in Iowa City and Clinical Psychology, Psychiatry and Pediatrics at the Illinois Masonic Medical Center in Chicago, and his fellowship in Neuropsychology at University of Iowa Hospitals in Iowa City.Dr. Levin started his career in 1972 as Instructor with the Department of Psychology at the University of Iowa and transitioned to The University of Texas Medical Branch (UTMB) in Galveston, Texas, in 1974, where he began an internationally renowned career in clinical work, teaching, and, most of all, pioneering research on traumatic brain injury (TBI). He ultimately became the Chela and Jimmy Storm Distinguished Professor in Surgical Research, Division of Neurosurgery, Department of Surgery in 1987. After leaving Texas for two years to take a position with the University of Maryland Medical System and Shock Trauma Institute in Baltimore, he moved back to Houston Texas in 1995 and established the Cognitive Neuroscience Laboratory (CNL) within the Department of Physical Medicine & Rehabilitation at Baylor College of Medicine, which was supported by federal grants, including funding from the National Institutes of Health, Department of Defense, Department of Veterans Affairs, and Centers for Disease Control and Prevention, and numerous private foundations. The CNL integrated rehabilitation and neuroplasticity research with multimodality brain imaging, clinical and neuropsychological assessment, and fluid biomarkers. Dr. Levin was Professor with the Departments of Physical Medicine and Rehabilitation where he served as Director of Research (1995-2014), Pediatrics, and Neurosurgery at Baylor College of Medicine. He was also a Research Scientist and the Director of the Center of Excellence for Traumatic Brain Injury at the Michael E. DeBakey Veterans Affairs Medical Center (2008-2013), and Adjunct Professor with the Department of Psychology at Rice University in Houston, Texas.Dr. Levin’s research focused on investigating both acute and long-term outcomes of mild to severe TBI in civilian and military populations, including cognitive and behavioral sequelae in relation to neuropathology using advanced brain imaging modalities. He began prospective, longitudinal studies of adults and children who had sustained TBI associated with closed head trauma upon joining UTMB and developed, in collaboration with Drs O’Donnell and Grossman, the Galveston Orientation and Amnesia Test (GOAT). The GOAT was the first measure to assess post-traumatic amnesia and orientation following moderate to severe TBI, is still most widely used by the clinicians and researchers, and it has been translated to 16 languages. The original publication, “Levin HS, O’Donnell VM, Grossman RG. The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis. 1979 Nov;167(11):675-84. doi: 10.1097/00005053-197911000-00004. PMID: 501342”, has over 1200 citations. This work continued with participation in the NINDS Traumatic Coma Data Bank and the organization of outcome assessments for NINDS-funded clinical trials of hypothermia to treat severe TBI. To monitor the quality of outcome data across performing sites, Dr. Levin and colleagues developed a code for the reliability of data collected and implemented the role of an outcome monitor who evaluated adherence to protocol across sites. Following establishment of the CNL, he pursued investigation of TBI outcomes across the lifespan using multimodality brain imaging and biomarkers, errorless learning, translational studies in collaboration with neuroscientists using animal models, and clinical trials of methylphenidate, progesterone, CDP-choline. Dr. Levin spent over 30 years researching neurobehavioral outcomes of head injury in children, starting with a small pilot study funded by the Shriners Hospital in 1991 and continuing with several cycles of a multicenter R01 grant funded by the National Institute of Health. In later years, he used his expertise as a member of several large consortiums, including the Long-term Impact of Military-Relevant Brain Injury Consortium \ Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) funded by the VA and DoD and the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) funded by the NINDS.During his career, Dr. Levin authored and coauthored more than 400 articles in scientific journals and over 100 books, with one of them, “Levin, H. S., Benton, A. L., & Grossman, R. G. (1982). Neurobehavioral consequences of closed head injury. Oxford University Press, USA”, having over 1100 citation, as well as book chapters that advanced knowledge of TBI, epilepsy, neurodegenerative diseases, and other illnesses that affect brain functioning. He was also very active as a reviewer on federal grant panels and as an editor and reviewer for the Journal of Neurotrauma, Journal of Clinical and Experimental Neuropsychology, Archives of Physical Medicine & Rehabilitation, Neuropsychology, Journal of the International Neuropsychological Society, Lancet, JAMA, Pediatrics, and other top-cited journals. He served as president of the International Neuropsychological Society in 1989-1990. Dr. Levin was a recipient of numerous prestigious awards, including the Javits Neuroscience Investigator Award, the Jennett-Plum Award for Research on Traumatic Brain Injury, the Distinguished Career Award by the International Neuropsychological Society, the American Congress of Rehabilitation Gold Key Award, the Distinguished Lifetime Contribution to Neuropsychology Award from the National Academy of Neuropsychology, as well as awards from other head injury and psychological organizations, including the International Brain Injury Association, the National Head Injury Foundation, the North American Brain Injury Society, Texas Psychological Association, and the Defense and Veterans Brain Injury Center. In addition to his stellar scientific accomplishments, Dr. Levin trained, mentored, and provided supervision to interns, fellows, postdocs, residents, medical and psychology students. He was the Director of an NCMRR/NIH T32 Postdoctoral Research Program, and training supervisor in neuropsychology for Baylor College of Medicine and for the Memorial Hermann TIRR Neuropsychology Postdoctoral Fellowship Programs. A passionate educator, he taught classes at Baylor College of Medicine, the University of Houston, and the National and Kapodistrian University of Athens Medical School in Greece and served as an evaluator for the American Board of Clinical Neuropsychology/American Board of Professional Psychology. He was often invited as a lecturer at numerous scientific organizations.The main objective of this symposium is to provide an overview of the current state of research in TBI while highlighting Dr. Levin’s contributions to this field. The symposium will start with a brief overview of Dr. Levin’s career (Dr. Randall S. Scheibel), followed by presentations focused on the assessment of adult TBI, including posttraumatic amnesia (Dr. Felicia C. Goldstein), the current state of pediatric TBI (Dr. L. Ewing-Cobbs), and novel imaging in TBI (Dr. Erin D. Bigler). There will be a brief discussion session at the end lead by Dr. Elisabeth A. Wilde.

For neurologists and psychiatrists, this month's edition of CNS Spectrums contains both original research articles and review papers surrounding a central theme of enormous importance: how the environment can harm brain function and how the brain can repair itself. We are extremely fortunate to have Jeremy Coplan as our guest editor. Dr. Coplan, with whom I have enjoyed years of collaboration on many projects of mutual interest, is professor of psychiatry at the State University of New York (SUNY) Downstate Medical Center in Brooklyn and senior scientist in the Department of Clinical Psychobiology at the New York State Psychiatric Institute in New York City. Let me now summarize why I believe the area covered this month is so vital.

Cannabis is one of the most commonly elicited substances abused. It is easily accessible, inexpensive, and the ultimate gateway drug. Synthetic cannabinoid has been known to be packaged under numerous trade names such as “K2, spice, AK-47, Geeked up, Smacked, and Green Giant..etc”. K2 Abuse has been rising more recently in New York State, especially among lower socioeconomic areas and among younger male individuals. Clinicians should be educated and awareness should be increased regarding patient presentation, treatment, as well as management. Although, treatment is ultimately supportive therapy, long term management to prevent future abuse is of prime importance. Death is rare but there can be serious risks associated with K2 abuse.Case presentationPatient is a 36-year-old male with unknown PMH who presented with bizarre behavior and anxiety. Patient was uncooperative and portraying repetitive tangential thoughts. He was found agitated, screaming “I am king of the world, and I feel good”. The patient admits to waking up this morning and smoking marijuana and his last memory since then was being in the ambulance. The patient denies any psychiatric medical history but is unable to provide any further details. The patient's family reports unusual behavior in the past few days such as religious connotations, nonsensical rantings, and repetitive thoughts causing them to contact emergency medical services. The family also admits to depressive episodes as well as suicidal ideations found in his personal written lyrics. He admits to drinking 1 pint of various types of liquor well as 6+ beers per day for >15 years. He denies any history of smoking, although he does smoke marijuana daily as per family.On physical exam his vital signs were normal. Patient was tearful and exhibiting repetitive thoughts, despite having a somnolent general affect. The rest of the physical exam was within normal limits. Patient received intravenous crystalloid fluids, Haldol 5 mg IV, and Benzodiazepine IV. Pertinent laboratory findings is significant for elevated lactate 3.4, hypokalemia 2.2, and an elevated ammonia 53. Other laboratory findings were within normal limits. CXR and Head CT showed no significant findings and EKG was within normal limits.Hospital course complicated with aspiration pneumonia. Patient received a full course of antibiotic therapy. Blood and urine culture showed no growth through admission. Social worker and case manager were involved and patient was offered referral to chemical dependency programs which he refused. Patient was discharged in stable condition and asked to follow up with primary care physician.DiscussionThe recreational use of synthetic cannabinoids such as K2 has been on the rise especially in younger male individuals and in lower socioeconomic status neighborhoods. In turn, the number of admissions secondary to acute intoxication has been increasing in hospitals all over the nation. More recently, since the advent of synthetic cannabinoids, there has been two reported confirmed deaths in New York City associated with K2 abuse. This can be attributed the drugs widespread accessibility. Synthetic marijuana has been legally available in the internet, local smoke shops, and even convenience stores. K2 has been advertised as the new, legal, and more cost effective way to get “high”. The popularity of this new class of drug “fad” is increasing in popularity as an alternative to marijuana and will continue to be a growing health concern.The use of K2 and other synthetic forms of recreational substances has become an escalating problem in many institutions nationwide. Increasing awareness will allow for improved preparedness as well as provide further data on this situation. .

AbstractIntroductionWhen the SARS-Cov2 virus hit the New York and New Jersey metropolitan area in Spring 2020, hospitals and hospital workers were hit hard with a new unknown pathogen that either killed people or made them very ill. There were large numbers of severely ill patients that strained resources. Hospital workers had extraordinary stress with multiple additional patients, the need to use personal protective equipment (PPE) in short supply, and faced with a pathogen that had no treatments beyond care and support initially.MethodsWe surveyed our hospital workers in late Spring 2020 to identify the main stressors and find out what measures were helpful. An online anonymous survey included questionnaires about sleep, mood, outside stressors, helpful measures, and how they coped generally. All levels of hospital workers were surveyed. Resources were provided to all respondents.ResultsOver 240 individuals responded to the survey; most respondents were women (76%). ‘Workplace stressors’ topped the chart for 98 of our respondents. The worst workplace stressor that was cited was ‘irritable workforce,’ but ‘lack of ‘protocols’ and ‘shortage of PPE’ were also cited as stressors. ‘Other’ (not described) and ‘taking care of an ill relative’ were rated highly. Those who had ‘symptoms everyday:’ Anhedonia (loss of pleasure or interest), 13%; feeling down and hopeless, 12%; sleep disturbance, 41%; low energy, feeling tired, 29%; appetite disturbance, 26%; poor concentration and attention, 15%. Respondents told us what resources they used and what was most helpful; exercise was most frequently cited as helpful.Lessons Learned and DiscussionVarious resources for formal and informal mental health support were provided to all respondents at the time of survey. Our hospital mounted its own response with support services, as did our medical school and university. A "warm line" was available through the Department of Psychiatry from late March 2020; tip sheets and online groups were widely circulated; State Department of Health provided resources. There were formal peer support sessions and workers helped each other. Medical students provided child care, shopping, and transport. We learned that extra support for workers and more frequent rest and recharge time are important. A weekly "town hall" was instituted and a weekly update about the hospital and support in healthy activities are widely circulated to employees. Those with active PTSD (some were very disturbed by the number of deceased patients) were referred to professional providers. Hospitals need to be ready to deal with epidemics and pandemics more effectively in order to mitigate stress and support workers. Being prepared, not just with equipment, but with protocols in how to proceed should another pandemic come. We learned that listening to workers is important. Workers also need to know how valued they are.FundingDepartment of Psychiatry, New Jersey Medical School

AbstractIntroduction:Surge capacity is defined as a healthcare system's ability to rapidly expand beyond normal services to meet the increased demand for appropriate space, qualified personnel, medical care, and public health in the event of bioterrorism, disaster, or other large-scale, public health emergencies. There are many individuals and agencies, including policy makers, planners, administrators, and staff at the federal, state, and local level, involved in the process of planning for and executing policy in respect to a surge in the medical requirements of a population. They are responsible to ensure there is sufficient surge capacity within their own jurisdiction.Problem:The [US] federal government has required New York State to create a system of hospital bed surge capacity that provides for 500 adult and pediatric patients per 1 million population, which has been estimated to be an increase of 15–20% in bed availability. In response, the New York City Department of Health and Mental Hygiene (NYC DOH) has requested that area hospitals take an inventory of available beds and set a goal to provide for a 20% surge capacity to be available during a mass-casualty event or other conditions calling for increased inpatient bed availability.Methods:In 2003, under the auspices of the NYC DOH, the New York Institute of All Hazard Preparedness (NYIHP) was formed from four unaffiliated, healthcare facilities in Central Brooklyn to address this and other goals.Results:The NYIHP hospitals have developed a surge capacity plan to provide necessary space and utilities. As these plans have been applied, a bed surge capacity of approximately 25% was identified and created for Central Brooklyn to provide for the increased demand on the medical care system that may accompany a disaster. Through the process of developing an integrated plan that would engage a public health incident, the facilities of NYIHP demonstrate that a model of cooperation may be applied to an inherently fractioned medical system.

IntroductionMild cognitive impairment (MCI) is common in older adults and represents a high-risk group for progression to Alzheimer’s disease (AD). Medication trials in MCI have generally failed, but new discoveries with brain plasticity in ageing have led to the study of cognitive training as a potential treatment to improve cognitive abilities. Computerised cognitive training (CCT) involves computerised cognitive exercises that target specific cognitive abilities and neural networks to potentially improve cognitive functioning through neuroplasticity.Methods and analysisIn a two-site study (New York State Psychiatric Institute/Columbia University Medical Center and Duke University Medical Center), we will randomise 100 patients with MCI (Wechsler Memory Scale-III Logical Memory II score 0–11; Folstein Mini Mental State Examination ≥23) to home-based CCT (suite of exercises: memory, matching, spatial recognition, processing speed) or a home-based active control condition (computerised crossword puzzle training (CPT)) with 12 weeks of intensive training followed by regular booster sessions up to 78 weeks. All patients will receive standard neuropsychological and functional assessments in clinic as well as structural/functional brain MRI scans at study entry and endpoint. We will test if CCT, versus CPT, leads to improved cognitive functioning, transfers to functional ability and tasks of everyday life and impacts hippocampal volume changes and changes in the default mode network of the brain measured by resting-state functional MRI.Ethics and disseminationThe study will be conducted following ethics approval and written informed consent will be obtained from all subjects. Study results will be disseminated via publication, clinicaltrials.gov, media and conference presentations. This will be the first controlled long-term trial to evaluate the effects of home-based CCT versus computerised CPT on cognitive abilities and functional measures and neural outcomes as determined by MRI indices in patients with MCI. Positive results from trial may support further development of home-based CCT.Trial registration numberClinicalTrials.gov identifier (NCT03205709).

Mounting interest in Europe over the incorporation of the human biological model in the laboratory has been fuelled by scientific advances and the much improved accessibility to human tissue. The collection of tissue is complicated by a host of ethical considerations and lack of public awareness of the benefits of donation to research and education. In the United States, the International Institute for the Advancement of Medicine (IIAM) has been successful in networking the cooperation of organ banks, tissue banks and hospitals, to collect otherwise discarded anatomical gifts with consent from the donor or donor's next of kin for medical research applications. IIAM is a non-profit, non-transplant anatomic bank that is provisionally licensed in the state of New York- one of the first states to implement comprehensive licensing procedures. Over the last year, IIAM has been serving a growing number of investigators in Europe with both fresh and frozen preparations. However, the various logistical problems in transAtlantic transportation and economic considerations warrant the exploration of establishing a satellite bank in Europe that would entail a more efficient and cost effective service to this region. This permanent facility would have access to IIAM's frozen inventory of tissue and tissue-derived protein samples, and would serve to facilitate the provision of fresh tissue, cells and slices to European researchers requiring such materials for their studies.

The take-off of psychopharmacology in the mental-hospital world began in the vast asylum system of New York State in the early 1950s. Henry Brill ordered the state system to introduce chlorpromazine in 1955, which led to the first decrease in the census of the state asylum system in peacetime. Sidney Merlis and Herman Denber implemented chlorpromazine in their hospitals and, with Brill, began a series of publications on the drugs and their efficacy. Pharmacologist and psychiatrist Joel Elkes established the first department of experimental psychiatry in the world in 1951 at the University of Birmingham in England. Finally, the chapter examiunes the historical heft of the National Institute of Mental Health, which in 1953 opened the “intramural” (in-house) research program where much of the research in psychopharmacology done in the United States has occurred.

Abstract Maria A. Oquendo is the Ruth Meltzer Professor and Chairman of Psychiatry at the Perelman School of Medicine at the University of Pennsylvania and Psychiatrist-in-Chief at the Hospital of the University of Pennsylvania. Dr Oquendo graduated Summa cum Laude, Phi Beta Kappa from Tufts University in 1980. She attended the Vagelos College of Physicians and Surgeons of Columbia University and completed her residency training at the Payne Whitney Clinic of New York Hospital Cornell. Until 2016, she served as Professor of Psychiatry and Vice Chairman for Education at Columbia University and the New York State Psychiatric Institute. In 2017, she was elected to the National Academy of Medicine, one of the highest honours in the fields of health and medicine. Her expertise is in the diagnosis, pharmacologic treatment, and neurobiology of bipolar disorder and major depression with a special emphasis on suicidal behaviour and in global mental health. She is past-President of the American Psychiatry Association.

Abstract The Neurological Institute of New York was founded in 1909. Historical accounts laud it as the first hospital in the United States devoted to patients with neurological diseases.2,3 But that was only partly true. Neurologists in those days were called “neuropsychiatrists,” necessarily so. The specialty had originated during the Civil War, not even 50 years earlier. Neurological diseases were impervious to available treatments, and it is now difficult to think of a single condition other than epilepsy that could have been treated effectively with a drug or surgery. Another push for the hybrid term came from patients, who felt stigmatized by a psychiatric diagnosis and preferred to be admitted to a neurological hospital rather than an psychiatric hospital. Besides, psychiatrists were mostly in charge of asylums hidden in distant sites, remote from big cities. From the beginning and continuing for more than 50 years, many—perhaps even most—patients admitted to the institute probably had psychiatric disorders. Since the 1950s, however, advances in neuroscience have totally transformed the specialty, moving treatment to center stage for many conditions, even though giant public health challenges remain to this day; Alzheimer disease claims more than 4 million people now, and Parkinson disease is closing in on another million.

Abstract Paul Summergrad, is Dr Frances S. Arkin professor and chairman of the Department of Psychiatry and professor of psychiatry and medicine at Tufts University School of Medicine and psychiatrist-in-chief at Tufts Medical Center, Boston, Massachusetts. An international leader in medical psychiatric disorders and care, Dr Summergrad’s research focuses on mood disorders, medical-psychiatric comorbidity, and health system design. Dr Summergrad earned his medical degree from the School of Medicine at the State University of New York at Buffalo in 1978 where he was elected to Alpha Omega Alpha in his junior year. He completed psychoanalytic training at the Boston Psychoanalytic Society and Institute. In 2014–15, Dr Summergrad served as the 141st President of the American Psychiatric Association, and is a past-President of the American Association of Chairs of Departments of Psychiatry. He is currently Secretary for Finanace for the World Psychiatric Association.